Postoperative upper extremity lymphedema is a common postoperative complication in breast cancer patients, which greatly affects patients' quality of life and confidence in treatment. Currently, western medicine has limited effect in treating postoperative upper extremity lymphedema after breast cancer, and acupuncture has better efficacy in treating this disease, however, there is no research on the choice of different acupuncture treatment modalities.
To compare the efficacy of different acupuncture modalities on upper extremity lymphedema after breast cancer surgery using reticulated meta-analysis, with a view to providing an evidence-based basis for the selection of clinical treatment options.
A computerized systematic search of the China national knowledge infrastructure, Wanfang Data, VIP, China Biomedical Literature Service, PubMed, Embase, Medline and Cochrane Library databases of randomized controlled trials (RCT) on the intervention of different acupuncture modalities in postoperative lymphedema after breast cancer was conducted from the time of database construction to October 31, 2023. The literature search was completed independently by two researchers, and the initial and re-screening were performed in strict accordance with the inclusion and exclusion criteria. After the final inclusion of the literature was categorized, the basic information and data were extracted and the risk of bias was assessed, and the data were analyzed using software such as R 3.6.2 and Stata 14.0.
Fourteen papers were finally included, containing a total of 915 patients with upper limb lymphedema after breast cancer surgery, including 459 cases in the treatment group and 456 cases in the control group. Eleven interventions were involved, including conventional treatment, ordinary acupuncture, warm acupuncture, millifire acupuncture, western medicine, acupuncture+moxa stick, conventional+abdominal acupuncture, conventional+warm acupuncture, conventional+acupuncture, conventional+guanxi, and conventional+forceful motion acupuncture. The results of the ranking of the cumulative probability plot area under the curve (SUCRA) of each intervention on the difference between the affected-patient side circumferential diameters showed that the results of routine + abdominal needling (100.0%) >milli-fire needling (66.4%) >routine + warm needling (58.2%) >regular needling (19.0%) >routine (6.5%) . The results of SUCRA ranking of each intervention on the total efficiency showed that milli-fire acupuncture (90.1%) >ordinary acupuncture (71.1%) >routine+force-activated acupuncture (67.7%) >warm acupuncture (62.1%) >routine + warm acupuncture (57.9%) >acupuncture+moxa sticks (50.7%) >routine +off-needling (48.2%) >routine+needling (47.7%) >routine + abdominal needling (38.6%) >western medicine (9.6%) >routine (6.3%) .
Among the 11 interventions, the combined total efficiency and the ranking of the difference between the affected-healthy side circumference showed that millipede acupuncture is the best choice for the treatment of upper extremity lymphedema after breast cancer surgery, but more high-quality RCTs are needed to confirm this.
Posterior circulation ischemic vertigo (PCIV) can often be used as a precursor symptom of cerebral infarction. It has the characteristics of recurrent attacks, lingering and non healing, which seriously affects the quality of life of patients. However, the clinical efficacy of conventional western medicine treatment is limited. At present, traditional Chinese patent medicines and simple preparations injection has significant efficacy in controlling and alleviating the onset of vertigo. However, in view of the wide variety of traditional Chinese patent medicines and simple preparations preparations, there is a lack of relevant evidence-based medical evidence to evaluate the advantages and disadvantages of various traditional Chinese patent medicines and simple preparations injections.
To evaluate the efficacy and safety of different Chinese herbal injections combined with conventional western drugs in the treatment of PCIV using reticulated Meta-analysis.
A comprehensive search was conducted on CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Web of Science, and Cochrane Library up to May 7, 2024, for randomized controlled trials involving TCM injections for the treatment of PCIV. Randomized controlled trial (RCT) on the treatment of post-circulatory ischemic dizziness with herbal injections. The Cochrane risk of bias tool was used to evaluate the quality of the included literature, and RevMan 5.4 and Stata 17 software were used for data analysis.
Forty-nine RCT with 4 556 patients were finally included, involving 13 types of traditional Chinese medicine injections, including Danshen Chuanxiongqin injection, Danhong injection, Shenxiong Putaotang injection, Shenmai injection, Tianmasu injection, Dengzhanhuasu injection, Shuxuetong injection, Honghuahuangsesu injection, Shuxuening injection, Kudiezi injection, Gegensu injection, Xingnaojing injection, Yinxingdamo injection. Net Meta-analysis showed that in terms of vertigo symptom improvement[i.e. Dizziness Disorder Inventory (DHI) score]: the top 3 SUCRA-ranked interventions were Xingnaojing injection (87.2%) , Shenmai injection (73.5%) , and Shuxuening injection (59.6%) in combination with conventional western medicine, respectively; In terms of total clinical effectiveness: the top 3 SUCRA-ranked interventions were Yinxingdamo injection (88.3%) , Tianmasu injection (63.3%) , and Gegensu injection (57.6%) in combination with conventional western medicines, respectively; In terms of improvement of blood flow velocity in left and right vertebral arteries: the top three interventions were Xingnaojing injection (96.2%, 99.2%) , Dengzhanhuasu injection (90.2%, 85.6%) , and Honghuahuangsesu injection (69.3%, 79.4%) in combination with conventional western medicines; In terms of improvement of blood flow velocity in basilar arteries: the top three interventions were Dengzhanhuasu injection (97.6%) , Honghuahuangsesu injection (85.8%) , and Xingnaojing injection (80.6%) in combination with conventional western medicine; In terms of the improvement of whole blood high cut viscosity, the top three interventions were Shenmai injection (85.6%) , Danhong injection (80.0%) , and Shuxuetong injection (77.5%) in combination with conventional western drugs, respectively; In terms of the improvement of whole blood low cut viscosity, the top three interventions were Shuxuetong injection (90.3%) , Tianmasu injection (77.5%) , and Shenmai injection (73.0%) in combination with conventional western drugs, respectively. In terms of safety: no serious adverse drug reactions occurred in all studies.
Xingnaojing injection combined with conventional western medicine showed excellent clinical efficacy in improving PCIV vertigo symptoms and vertebral basilar artery blood flow velocity, which provided a certain reference for clinical medication, and the combination of traditional Chinese patent medicines and simple preparations injection and conventional western medicine was superior to conventional western medicine alone, and had good drug safety. However, the available evidence is limited by the quality and quantity of the included literature, and the above conclusions need to be further validated by more high-quality prospective RCT.
